Thoughtful Thursdays: Infertility, It’s complicated!

WARNING: This post is VERY long. Read at your own risk.

I was a Linguistics major in college. I know, I know, why study something useless like the study of language? Well, there is actually a lot you can do with it (who do you think helped create Google’s search algorithm) and teaching a foreign language doesn’t render it irrelevant either. I wasn’t really too worried about what I’d do with a Linguistics major when I started studying, all I knew was that all the classes that interested me were in the Linguistics department.

Studying Linguistics was a lot of fun; it was hard work but it was incredibly interesting. I enjoyed some really fascinating classes taught by well renowned professors. In one of those classes, Cognitive Linguistics, I was introduced to the idea of contested categories. We studied them more in Semantics, which is the study of the meaning of words.

At first glance it might seem facetious to dedicate an entire college course to the meanings of words, I mean isn’t that what dictionaries are for? The reality is words can mean much more than their mere definitions. The intention of an utterance sometimes veers drastically from the it’s dictionary definition. Sarcasm, irony, idiom, metaphor, cultural references, inside jokes, even the surroundings of a person can affect the meaning of words and phrases as they are uttered. When you really starting looking at it, it’s fascinating.

As far as definitions go, most words have pretty narrow denotations; these are the words that can be explained by limited entries in the dictionary. Other words are harder to pin down; some words have pages and pages of entries in the dictionary – entire columns of added prepositions creating entirely new phrases (get it, get up, get over it, get lost, etc). And some words might at first seem easily definable, but prove to be much more slippery and hard grasp a hold of.

Take “art” for example. What is art? Is art something that exists on a wall in a museum? Is art any painting or sculpture? Are murals art? If so, is graffiti art? What separates photographic art from the pictures you took on vacation? While you may think you know what “art” is, a probing inquiry would have you questioning yourself quite quickly.

Art is a contested category; it is a word that cannot be confined by everyone in the same way. While some things would probably be declared unanimously as art (Michaelangelo’s David), others linger on the edges of the definition, unsure of their place; one individual’s art (Banksy) is  another’s public nuisance.  In my head I visualize contested categories as Venn Diagram-like organizations with concentric circles here and overlapping circles there, the confines of which are ultimately blurry and difficult to determine.

I tackled a specific contested category in my final Semantics paper which was called The Contested Category and Metaphorical Extension of the Word “War”. It ended up being over 25 pages despite the requirement being a mere ten. Once I started digging into the difficulties of defining war I literally couldn’t stop. Is something a war only if two recognized nations with professional militaries are fighting? What if a country (the US) is fighting an amorphous terrorist group (Al Queda or Hamas) which lacks professional troops and exists in multiple countries? And what of the war on drugs? There are many who believe using the word “war” to define our stance against drugs has left the US with no other alternative than to “win” (stamp out all drug use) which is impossible. When we are at war with someone or something, any negotiated outcome that differs from the original goal is considered defeat.

Recently different articles and posts got me thinking about infertility as a contested category. Even before phrases like “circumstantial infertility” started getting thrown around I felt that infertility was a word consisting of concentric and overlapping circles, not to mentioned  a blurred edge.

The American Heritage Dictionary’s definition (from of infertility is:

  1.  Absent or diminished fertility.
  2.  The persistent inability to achieve conception and produce an offspring.

On the same page is a Medical Dictionary entry for infertile:

:not fertile

especially: incapable of or unsuccessful in achieving pregnancy over a considerable period of time (as a year) inspite of determined attempts by heterosexual intercourse without contraception

Of course everyone in the IF community knows it means much more than either of those things.

I’ve read many places that a couple is declared infertile if they’ve had unprotected sex for a year without achieving pregnancy. I’ve also read that for older couples the number goes down to six or sometime three months even though it will actually take older couples longerthan younger couples to get pregnant. This #-months-without-pregnancy definition seems more like a tool to provide couples with medical intervention; for that reason older couples can seek treatment more quickly, because their biological clocks are literally running out. Is one aspect of the word “infertility” only, in a way, a label to encourage treatment?

Infertility is caused by many things, some more easily explained than others. Infertility can be caused by hormone imbalances (thyroid issues, high FHS, POV), hardware malfunctions (uterine deformaties, scarring, lost/damaged fallopian tubes or ovaries), male-factor (low sperm count or motility) and conditions such as PCOS or endometriosis, to name a few. A large percentage of infertility cases are unexplained. For some women the problem is seemingly as simple as not ovulating. I suffered from unexplained amenorrhea (lack of menstruation) for years. For almost a decade I never had my period unless it was coaxed by months of birth control and even then it would only return for a few measly months. If I had tried to get pregnant during that time I would have been declared infertile.

At least I would have if I had waited for a year sans menstruation to ask for help. I think, though, that any doctor would have seen me after a few months of missing my period in which case they probably would have given me Clomid or some other drug to induce ovulation. When a person needs medical intervention to ovulate, but didn’t wait a year to take it, is she infertile? What about a woman who waits until she is 45 to try to conceive a child? When treatment is almost certainly necessary because of age, is that person infertile? Here is where the lines start to blur.

Western medicine provides many amazing remedies for infertility. Sometimes all that is needed is a drug to help spur ovulation. Other times more invasive treatments are necessary. Assisted Reproductive Technologies (ART) are as numerous as they are varied and they are a defining characteristic of infertility. Two common treatments are intrauterine insemination (IUI) and in vitro fertilization (IVF). IUIs are less invasive (and less expensive) than IVF, which includes surgery for the woman. I have witness many women rating their (and others’) infertility based on the degree of treatments endured. Those who only need Clomid may be considered less infertile than those who undergo IUIs. If a heterosexual couple needs IVF it is an undeniable sign that infertility is present and it is generally agreed that those who undergo the procedure endure the most difficult treatment. Those who must opt for donor embryos or eggs or choose adoption may suffer even greater financial and emotional hardship. Classifying someone’s infertility by the treatment they’ve had to undergo or the suffering they’ve endured seems to be quite common and plays a role in defining the word.

Suffering, inherent not just in the treatment but in the very inability to conceive, is a huge part of the word infertility, and in many ways defines it as much as the medical explanations. Everyone who deals with infertility suffers because of it. There is so much loss – the loss of hope, the loss of innocence, the loss of expectations and dreams, the loss of achieving a biological imperative. For many the loss of pregnancies or babies is also a part of infertility. Some women have no trouble achieving pregnancy but are unable to carry a child to term, miscarrying repeatedly. While these women are not considered infertile by the medical establishment, the result is the same: years of waiting for a child they cannot have without help. This common experience of being unable to produce a living child is all that is needed to include these women in the infertility community.

The common thread of wanting a family and being unable to have one is also what inspired the co-opting of the word in the term “circumstantial infertility”. This term was coined to describe people who want to have children but have not yet found a partner with whom to start a family. This term has created some controversy in the infertility community, as many continue fighting for infertility to be seen as a true medical condition and not a lifestyle choice (as some claimed it to be). Still, most infertile women recognize that the pain felt by any person who is unable to build the family is legitimate and should be validated by everyone, even those people who are medically, not circumstantially, unable to conceive.

A final aspect of the word infertility is it’s resolution. All people who suffer infertility will make decisions that define their path and their eventual outcome. Some have success with ART and build their families as they would have had they not suffered the disease. Others have their own biological children via a surrogate or carry a child themselves via adopted embryos. Some people choose adoption to build them families and others choose (or are forced) to live childfree.

When infertile couples are no longer trying to build a family are they still infertile? What if a couple needs treatment to have her first child but then doesn’t to have their second? What about the other way around, commonly called secondary infertility? My friend told me of a woman who just had her second child via IVF and has decided to stop blogging in the infertility community as she no longer considers herself infertile; she had achieved the family she always hoped to have. Are those women who now have the families they had always wanted still infertile? Most bloggers I know believe that even if they consider their infertility resolved (they are no longer trying to conceive) they are still infertile, but then again, many of them did not achieve the family they had always hoped to.

Infertility is a medical term but it affects every aspect of a person’s life. This insidiously ubiquitous quality creates multiple arenas in which infertility is defined: the medical cause, the time and money spent trying to achieve a successful pregnancy, the medical intervention that is required, the inability to build a family when and how one had hoped, the eventual resolution of the disease and of course the agonizing loss and suffering endured. In fact, it seems that the pain of infertility is what creates the blurred edge containing all the concentric and over-lapping circles that construct infertility’s overall meaning. The suffering is what truly holds all the different pieces of the infertility experience together. And even if infertility can be described as a contested category, in the end, no matter how you define or categorize it, for those who’ve experienced it, infertility = devastating loss.

How do you define infertility? Is that definition based primarily on your experience and the experience of others? Do you believe infertility is a contested category, or do you find it easy to define?

15 responses

  1. I am also fascinated by linguistics, semantics and the connotations of words. One thing that frustrates me to no end is that some members of my religion (Christian) have no concept of the origins and true meaning of words in the Bible. Some don’t understand that because the Bible was not written in English, when you translate into another language you are going to lose some of the original context and meaning. I think some Christians are so judgemental and legalistic because they refuse to dig deeper than just the English word on the page and what they think that means. But I digress…

    Infertility is extrememly difficult to define. I think those who haven’t been through it cannot understand how someone who has been successful at fertility treatments and has children can still call themselves infertile. It’s hard because like you said there are SO many causes of infertility and many of them are unknown. I tend to think, right or wrong, that if someone is physically unable to get pregnant without medical intervention, then they are infertile.

    For me personally, infertility is based on my experience. I do not consider myself infertile, even though I couldn’t get pregnant totally on my own to have my first (so maybe I just contradicted my statement from above). I needed Clomid and Metaformin and acupuncture, but once I had that combination, I was pregnant. Maybe I would feel differently had I required multiple cycles of this “cure” or more advanced and/or invasive treatments to get pregnant. And I guess I have hope that I’m not “really” infertile- that next time I want to get pregnant my body will do what it’s supposed to do. Oh my goodness, typing that I just had a revelation- maybe I am infertile and am just in denial because the fix was (relatively) easy the first time and I just hope I don’t need anything at all next time. Wow- I need to really think about this.

    Well, whether I am infertile or not, reading blogs of people in this communuty has definitely made me more sensitive to the issue and careful how I present myself, and my baby, in public and on the internet (namely Facebook). Although I do not claim to totally understand the pain of those who cannot have children, I do understand how this disease is far more than just physical- the emotional aspect affects every single aspect of a person’s life.

    Thank you for another thought-provoking post. And sorry for another all-over-the-place comment! You just make my brain go every-which-way sometimes!

    • I talk to my mom about the translation of the bible all the time. By the time it made it’s way to English how many times had it already been translated?! Some of the teachings could be so different from what we know them to be.

      It’s interesting that you don’t consider yourself infertile even though you needed to seek treatment to get pregnant. I’m going to talk more about how I feel about my own personal situation in next Thursday’s post.

      I took my mom over 2 years to have me and then she lost a child in the NICU and had three still births but she would never identify with this community while I’ve only had a history of what could have created infertility and one loss and I so identify with it. It’s interesting.

      I also never call myself infertile because I have too much respect for the people who have suffered so much more than me to use the word. I can’t imagine how hard it must be for so many women who can’t have children or can’t have them in the ways they wany. My heart aches for them.

  2. Infertility is such a loaded word that I was afraid to embrace it. My blog post entitled Confessions of an Infertile Fraud is still one of my most popular posts… I think people were expecting to discover that I had been lying. But despite their palpable disappointment in the lack of gossip, my commenters all reassured me that we were an inclusive community and I didn’t have to be afraid of rejection. So I use it now.

    And now a totally different thought related to this post… A gal who I knew from high school has for years wanted nothing more than to have a baby. She wasn’t dating nice guys. She married a guy who definitely wasn’t nice (and divorced him only months later). All the while she grieved not having a baby. I get that – she clearly wanted a baby as much as I did (or more). So this week, she posted an ultrasound picture. She had taken matters into her own hands and made the decision to be a single mom. I think I should feel as happy for her as I do for infertile women who finally get pregnant. But I didn’t feel that way at all. I felt annoyed. Honestly, a little more annoyed than the typical facebook ultrasound makes me. And I suspect it’s because her circumstantial infertility was so easily cured. (I’m not saying it was an easy decision or that her life will be easy as a single mom… just that getting pregnant and staying pregnant past the first trimester wasn’t an ordeal.) I know my thinking wasn’t rational – but that is what I felt in the moment.

    • Can you send me the link to that post? I really want to read it.

      Thank you for sharing about your friend on Facebook. I think I would feel similarly to you, I would be frustrated that she could so easily get pregnant. At the same time, I can’t imagine becoming a mother by myself. It would be so incredibly hard and isolating. Marriage is definitely more difficult after children but I’d be lost without my partner. Still, I think if I were still waiting for my own child I would be very frustrated that my friend could get pregnant so easily. It would be an interesting lesson in not having everything you want though, and wondering which part of the equation is most important to us. Do you think you’d have felt differently if you already had you beautiful baby with you? Just curious?

      Please do send that link. I really want to read that post!

      • ” It would be an interesting lesson in not having everything you want though, and wondering which part of the equation is most important to us.”

        You’re living this lesson right now and sharing it with all of us as you try to balance your desire for a second child with your desire to live in the city and your partner’s desire for a meaningful job and your desire to spend a year at home and your desire to be able to have electricity and put food on the table. It’s a lesson you are teaching very well that has me constantly thinking and prioritzing.

  3. Your post was so refreshing and insightful.

    I have long struggled with the idea of not being “super” infertile. We’ve had losses, and been trying with clomid & monitoring, but haven’t made the step to IUI or IVF. Sometimes, when I’m participating in the online ALI community I feel a bit like an impostor; I read about women’s stories of trying for years and I feel guilty for being so wrapped up in my own issues. Of being so upset that we don’t have our own baby yet.

    Thank you so much for discussing this — it really is something that needs to be shared! I think it is important for the stigma of infertility issues to disappear, but for that to happen all of us in the ALI community need to come together; we need to support each other in whatever “degree” of infertility we face.

    Thanks again!

    • I very much no how you mean when you say you feel like an impostor. In fact, if you check out my blog next Thursday you will hear more about that.

      I think you’re absolutely right that as a community we need to open our doors to anyone who is struggling, even if it hasn’t been for as long as we have. While I understand that the “veterans” might feel differently about that, and they have every right to, I would hope they could remember what it was like when they were just starting out, how scared and unsure they felt. Many do.

      Thanks for commenting. I hope you can read next week’s post. I think you’ll really enjoy that one.

  4. I don’t like the term ‘circumstantially infertile’.
    How can you be infertile, if you haven’t gotten to the TTC stage yet?
    Circumstantially childless, yes. And I can see that there are some similarities with what people in the ALI community go through. But there are also great differences.

    Do I consider these people not welcome? No. We all decide on our own who we read and who we don’t. No one decides who is in our out.

    • I understand what you mean. For most people infertility is about the actual ability to get pregnant. I thought it was interesting that the author of the article was trying to co-opt the word for her own set of circumstances. I was wondering what she hoped to achieve by doing that. Was she hoping to be except by the community? For “fertiles” to understand how she saw herself? I didn’t really get it.

  5. Very thought-provoking.

    I once pointed out to an ALI friend that becoming a mom (via adoption) DID cure infertility for me. She pointed back that no, I still was not able to conceive/bear a child.

    But you hit on what I was trying to say: that infertility was resolved for me because I was no longer trying to conceive.

    There’s a lot to think about in this post. I think linguistics is fascinating and if I had it to do over, I might study that. I read once that the denotation of the Greek word “virgin” was simply “young girl.”

    Much of western civilization pivoted on the connotation of that word.

    (BTW, not sure of the veracity of that claim.)

  6. Such an interesting post. I think what we should take away from it is that we cannot be too concrete in how what perceive something to mean – a term that means one thing to me might have very different connotations to someone else, and we need to respect that (and I think in general this ALI community is very good at doing that).

    I personally don’t think that classifying someone’s infertility by the invasiveness of their ART or how the difficulty of their IF journey is a helpful or accurate representation of IF.

    Being unable to have a much longed-for child is painful. Pain is pain – regardless of the length or type of journey someone might travel on their family-building path.

    By which I don’t mean to minimize the suffering of those who have terrible, heart-breaking experiences while TTC.

    I had a successful pregnancy after two rounds of Clomid. I had few side effects from the drug. My pregnancy was (relatively) uncomplicated. I certainly had it easier than so many other women. BUT – I have read many blogs and connected with many women with different experiences, and what I have learnt is that the pain, fear and uncertainty that I experienced while TTC for many, many months before I achieved that pregnancy was much the same as those other women.

    I have never felt like I was being judged for being “less infertile” than anyone else – and for that I would like to thank you all.

    Yes, infertility has many different definitions – and they each serve a purpose. But I agree that in the end it is pain that truly defines it.

  7. Fascinating post! Thank you for sharing. As someone who classifies myself as a “secondary infertile,” at times over the years I struggled with how I compare to those who have dealt with primary infertility. Yes, it *only* took me 10 months/8 cycles to conceive my now almost 8 YRO son on our own, but them it took me over 5 years (including 2 early m/c, an interstitial ectopic, 2 failed IVF cycles, 1 IVF converted to IUI that also failed, 1 FET that worked but led to the birth and death of our daughter just shy of 30 weeks gestation) to bring home our third child/2nd daughter (who somehow after all that we conceived on our own). Go figure?!

    I agree that pain is pain and loss is loss. I don’t believe in many absolutes and life and think there are a lot of grey areas. I do think I have had an extremely difficult journey to build my family. But I don’t think that makes me better or worse than anyone else who has dealt with IF (in any way, shape or form). That said, I do think there is a significant difference between what a person has exeperienced in life vs. someone else and whether or not they feel a connection. Though now I am starting to read a wider range of blogs, even beyond IF, early on (when I started blogging 4 years ago), I felt more comfortable connecting with others who had similar paths to mine, such as SIF, recurrent pregnancy loss (which I have heard when you have three in a row it = infertile diagnosis, at least by HMO insurance terms) and then neonatal death.

    Anyway, I try to be an open-minded and inclusive person, especially in the ALI Comminity. As somewhat of a “veteran” myself, I try to stay involved in hopes of being a resource and support for those who are following in my footsteps. I find some comfort and validation in believing that by helping others as a “wounded healer,” that my pain and suffering on the road o build my family was not all in vain.

    Thanks again for this very interesting and thought provoking blog entry Esperanza! Going to go read today’s follow up. 🙂

    • Thank you so much for your thoughtful comment. And thank you for sharing some of your story with me. It sounds like a very difficult road to have traveled. I’m so sorry for your loss. I also don’t think that someone’s suffering can be rated or makes them more or less infertile, but I feel like I see that sometimes in this community. I generally don’t believe people are even trying to do it, but it happens all the same. I think it’s about people looking for connections through common experiences and validation about what they’ve been through, but like you said, you don’t need to have been through something similar to be able to validate a person’s feelings about their loss. Thank you for being the veteran that helps those following in your footsteps. The journey would be a darker and scarier one without caring people like you.

  8. Pingback: NIAW & Where I Stand | Stumbling Gracefully

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